While working in ICU daily, we need to put sick patients on a ventilator support as a last hope to save them. As a doctor, we also are some times not sure whether the patient will be alright and come out from the ventilator support and can communicate with their loved ones (family) again or not...
Related to this I came across very nice article written by a foreign doctor Dr Michael E. Wilson with the heading:
" Saving a death when we cannot save a life in the Intensive Care Unit (ICU).."
In this article, he writes about the condition of the patients family when the patient is sick and being put on a ventilator support and they are not sure they will communicate with the patient again or not.
So he started "going off to war talk" policy in this situation. Its like when parents send their children off to a war they take a moment to say good bye.The best case scenario is that their sudden return home alive, but the worst case is that their parting words could be their last. Like this he allowed the relative of the sick patient going to be put on a ventilator support to have last words with the patient before putting on a ventilator because they are left without the ability to communicate, atleast temporarily or they may never recover. A "going off to war talks" would help patients and family members hope for the best, but at the same time prepare for the worst. Its a way to avoid "stealing last words from a person".
He did this on her female patient before putting her to sleep and on a ventilator support, he allowed patients husband to have a talk with her. Unfortunately patient could not survive and was declared dead on a ventilator. After a month he called patient's husband to know what were the last words he shared with his wife. He told, he said to her that he loves her and she told him she loves him too.. These were the last conversation they had. Among all the pain of unanticipated death, it gave him daily peace knowing that their last words to each other were "I love you".
What he would had not allowed to have last words before making patient to sleep and put on a ventilator ?
A meaningful conversation can often be facilitated event in urgent situation. Even if everything goes well and the patient eventually wakes and is removed from a ventilator having an opportunity to express love, encouragement or suppprt before intubation seems to strengthen family bonds.
In India, we hear that one should ask last wish from a dying person. But what about those people who are not even allowed to express their feelings to their loved ones, not allowed the loved ones to express their feeling for the patient before putting on a ventilator as they are not sure they will communicate with each other again or not.
This doesn't mean we are not hopeful in these patients that they will improve and go home with their loved ones. We hope all our patients should recover and go home happily. But we should also prepare them for worst case scenario, that this could be the last time they talked to each other.
While he could not save her life that day but he helped in some way to save her death. He wished he could have done the same for many patients before her.
I hope we too practice this way so that we can save a death when we cannot save a life..
When we miss a person what we remember about them are their last words.